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1 ' S�OFi Distance to Public Sewers Connection necessary: Yes— No_ <br /> Does existing septic system comply with Ord , t$549 : Yes— No_ <br /> Unknown IE no, explain: <br /> Describe septic installation to be installed: <br /> 2 , WATER SUPPLY <br /> Is water supplied by private well : Yes _ No_ Is well proper: <br /> Yes_ No State deficiency : <br /> Does existing or porposed use make this well public water: 'les <br /> No_.. Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGaJ-& a3= <br /> Licensed scavenger pick-up: Yes._ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: __ <br /> 4 . ELY. MOSQUITO OF. yFCTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TnILF.T BAT 1—ZAa1 d <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PRF.yrOnS nPrRATirt: HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> g . POPU .ATInN U^1�',; <br /> Appx. No . People per sq. mi . <br />